Das maligne neuroleptische Syndrom (MNS) – Eine systematische Übersicht

M. Nagel; S. Freisberg; K. Junghanns; C. K. E. Moll; B. Willenborg

doi:10.1055/s-0035-1553246

Fortschritte der Neurologie · Psychiatrie, Table of Contents

Fortschr Neurol Psychiatr 2015; 83(07): 373-380
DOI: 10.1055/s-0035-1553246

Übersicht

Das maligne neuroleptische Syndrom (MNS) – Eine systematische Übersicht

The Neuroleptic Malignant Syndrome

Authors

M. Nagel

¹Psychiatrie, Universität Lübeck
S. Freisberg

²Psychiatrie, Asklepios Klinik, Hamburg
K. Junghanns

¹Psychiatrie, Universität Lübeck
C. K. E. Moll

³Neurophysiologie, Universität Hamburg
B. Willenborg

¹Psychiatrie, Universität Lübeck

Abstract

Zusammenfassung

Hintergrund: Beim malignen neuroleptischen Syndrom (MNS) handelt es sich um ein potenziell lebensbedrohliches medikamenteninduziertes Krankheitsbild. Die Kernsymptomatik besteht aus Hyperthermie ohne Infektnachweis, Diaphorese (Schwitzen), Rigor der Skelettmuskulatur, wechselnder Bewusstseinsstörung und Erhöhung der Kreatinkinase im Blut. Ferner besteht eine vegetative Dysfunktion mit Herzfrequenz- und Blutdruckschwankungen.

Ziel dieser Übersichtsarbeit ist es, die aktuelle Studienlage zusammenzufassen und die Diagnosestellung des MNS bzw. die Abgrenzung von anderen Syndromen zu erleichtern. Darüber hinaus werden die therapeutischen Optionen, die beim MNS zu Verfügung stehen, erörtert.

Methode: Es wurde eine systematische Literaturrecherche durchgeführt. Es wurden Bücher, Fallberichte und Leitlinien eingeschlossen.

Ergebnisse: In dieser Übersichtsarbeit werden die aktuell gängigen diagnostischen Kriterien, die Differenzialdiagnose, die vermutete Ätiopathogenese und mögliche therapeutische Interventionen dargestellt.

Schlussfolgerung: Das frühe klinische Erscheinungsbild ist heterogen und macht die Diagnostik nicht leicht. Dabei ist eine frühe Behandlung wichtig für eine gute Prognose und rasche Rückbildung. Die Therapieoptionen richten sich nach der bisherigen klinischen Erfahrung auf der Basis von Einzelfallberichten und Expertenmeinungen. Bei der Diagnosestellung sollten die Kernsymptome beachtet werden: Einnahme von Dopamin-Antagonisten, Hyperthermie, Diaphorese, Rigor, Bewusstseinsstörungen, CK-Erhöhung und vegetative Dysregulation.

Abstract

Background: Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening medication-induced syndrome. Core symptoms are hyperthermia, diaphoresis, rigidity, impaired consciousness, and creatinine kinase elevation. Additionally, patients show vegetative dysregulation including blood pressure fluctuations. The purpose of this paper is to summarize current findings, to facilitate diagnostics and to distinguish NMS from other syndromes.

Methods: We performed a systematic review of the literature. We included scientific publications, books and guidelines.

Results: In this review we summarize the current diagnostic criteria, differential diagnosis, pathogenesis and therapeutic options.

Conclusion: Clinical symptoms of NMS are heterogeneous and it is difficult to diagnose early states. Early interventions are important to ensure fast and complete recovery. Since NMS is a rare condition, publications on NMS-therapy are based on single-case reports, meta-analysis or expert opinions. Core symptoms should be considered: Exposure to dopamine-antagonists, hyperthermia, diaphoresis, rigidity, mental status alteration, creatinine kinase elevation, and vegetative dysregulation.

Schlüsselwörter

malignes neuroleptisches Syndrom - Antipsychotika - Neuroleptika - Hyperthermie - akinetische Krise - Katatonie

Key words

neuroleptic malignant syndrome - antipsychotics - neuroleptics - hyperthermia - akinetic crisis - catatonia

Full Text

References

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